Retained products of conception after spontaneous and induced abortion: evolving paradigms

PURPOSE OF REVIEW: Retained products of conception (RPOC) are a complication following abortion. This review is timely as diagnostic standards are inconsistent and treatment paradigms are shifting from traditional vacuum aspiration and medication toward presumptively precision-based hysteroscopy. RECENT FINDINGS: Recent literature emphasizes that while ultrasound is the primary diagnostic tool, it suffers from high false-positive rates, particularly in asymptomatic patients. The integration of Doppler to identify enhanced myometrial vascularity is now recognized for risk stratification. While vacuum aspiration remains a cost-effective mainstay treatment for acute cases, emerging evidence suggests that targeted hysteroscopic removal without the use of vacuum aspiration of RPOC in select patients may offer benefits. Hysteroscopy can be more difficult to access logistically and financially. For patients desiring future pregnancy, both offer comparable long-term reproductive and live birth outcomes. SUMMARY: Management should be individualized. Expectant management is effective for stable patients with small, avascular remnants. Medication management offers a cost-effective alternative, with lower efficacy in those who have initially used medication to manage their pregnancy. In symptomatic or complex cases, ultrasound-guided or hysteroscopic interventions are preferred. Clinicians must balance the benefits of intervention against the risks of overtreating asymptomatic sonographic findings, taking into account patient preference and feasibility.